MCQ Quiz: Complex Infectious Disease Disorders

The management of complex infectious diseases requires pharmacists to possess a deep and nuanced understanding of pathophysiology, microbiology, and advanced pharmacotherapy. Conditions such as meningitis, infective endocarditis, tuberculosis, and Human Immunodeficiency Virus (HIV) present significant clinical challenges, often involving multi-drug regimens, significant drug interactions, and the management of opportunistic infections. For PharmD students, mastering these topics is crucial for effective participation in interprofessional teams and for optimizing patient care. This quiz will test your knowledge on the treatment guidelines, drug-specific parameters, and clinical decision-making involved in managing these serious and life-threatening infectious disease disorders.

1. A 65-year-old male is diagnosed with community-acquired bacterial meningitis. Empiric therapy should include coverage for Streptococcus pneumoniae and Listeria monocytogenes. Which regimen is most appropriate?

• a) Vancomycin + Ceftriaxone
• b) Vancomycin + Ceftriaxone + Ampicillin
• c) Meropenem alone
• d) Penicillin G

Answer: b) Vancomycin + Ceftriaxone + Ampicillin

2. What is the primary rationale for adding dexamethasone to the treatment regimen for suspected pneumococcal meningitis in adults?

• a) To provide synergistic antibacterial activity.
• b) To reduce intracranial pressure.
• c) To reduce the inflammatory response and decrease the risk of neurological complications like hearing loss.
• d) To prevent antibiotic resistance.

Answer: c) To reduce the inflammatory response and decrease the risk of neurological complications like hearing loss.

3. According to the modified Duke criteria, which of the following is considered a major criterion for the diagnosis of Infective Endocarditis (IE)?

• a) Fever greater than 38°C.
• b) Positive blood culture for a typical IE microorganism from two separate blood cultures.
• c) Presence of a vascular phenomenon like a mycotic aneurysm.
• d) Janeway lesions.

Answer: b) Positive blood culture for a typical IE microorganism from two separate blood cultures.

4. A patient is being treated for native valve endocarditis caused by methicillin-susceptible Staphylococcus aureus (MSSA). Which of the following is a preferred antibiotic regimen?

• a) Vancomycin
• b) Nafcillin or Oxacillin
• c) Daptomycin
• d) Linezolid

Answer: b) Nafcillin or Oxacillin

5. The standard initial phase of treatment for active, drug-susceptible tuberculosis consists of a four-drug regimen known as RIPE. What does RIPE stand for?

• a) Rifampin, Isoniazid, Pyridoxine, Ethambutol
• b) Ribavirin, Isoniazid, Pyrazinamide, Ethambutol
• c) Rifampin, Isoniazid, Pyrazinamide, Ethambutol
• d) Rifabutin, Indinavir, Pyrazinamide, Ethambutol

Answer: c) Rifampin, Isoniazid, Pyrazinamide, Ethambutol

6. Which medication must be co-administered with isoniazid (INH) to prevent peripheral neuropathy?

• a) Vitamin C
• b) Pyridoxine (Vitamin B6)
• c) Folic Acid
• d) Thiamine (Vitamin B1)

Answer: b) Pyridoxine (Vitamin B6)

7. A patient starting antiretroviral therapy (ART) for HIV is found to have a positive HLA-B*5701 test. Which medication is contraindicated?

• a) Tenofovir alafenamide
• b) Dolutegravir
• c) Abacavir
• d) Emtricitabine

Answer: c) Abacavir

8. What is the primary mechanism of action of integrase strand transfer inhibitors (INSTIs) like dolutegravir and bictegravir?

• a) They inhibit the viral reverse transcriptase enzyme.
• b) They prevent the cleavage of viral polyproteins.
• c) They block the integration of viral DNA into the host cell’s genome.
• d) They prevent the virus from binding to the CD4 receptor.

Answer: c) They block the integration of viral DNA into the host cell’s genome.

9. A patient with HIV has a CD4 count of 150 cells/mm³. Prophylaxis should be initiated to prevent which opportunistic infection?

• a) Mycobacterium avium complex (MAC)
• b) Pneumocystis jirovecii pneumonia (PJP)
• c) Cytomegalovirus (CMV) retinitis
• d) Cryptococcal meningitis

Answer: b) Pneumocystis jirovecii pneumonia (PJP)

10. What is the first-line treatment for Pneumocystis jirovecii pneumonia (PJP)?

• a) Atovaquone
• b) Dapsone
• c) Trimethoprim-sulfamethoxazole
• d) Pentamidine

Answer: c) Trimethoprim-sulfamethoxazole

11. The duration of therapy for prosthetic valve endocarditis is generally:

• a) Shorter than for native valve endocarditis.
• b) The same as for native valve endocarditis.
• c) At least 6 weeks.
• d) A single high-dose treatment.

Answer: c) At least 6 weeks.

12. A patient taking rifampin for tuberculosis should be counseled that it can cause which of the following?

• a) A metallic taste in the mouth.
• b) Blue discoloration of the skin.
• c) Red-orange discoloration of bodily fluids like urine and tears.
• d) Severe photosensitivity.

Answer: c) Red-orange discoloration of bodily fluids like urine and tears.

13. Which class of antiretroviral medications is well-known for causing a significant number of drug-drug interactions by inhibiting cytochrome P450 3A4?

• a) Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
• b) Protease Inhibitors (PIs), especially when boosted with ritonavir or cobicistat.
• c) Integrase Strand Transfer Inhibitors (INSTIs)
• d) Fusion inhibitors

Answer: b) Protease Inhibitors (PIs), especially when boosted with ritonavir or cobicistat.

14. What is the preferred treatment for latent tuberculosis infection (LTBI)?

• a) A 2-month course of RIPE therapy.
• b) A 12-month course of isoniazid alone.
• c) Short-course regimens like 3 months of once-weekly isoniazid plus rifapentine.
• d) No treatment is necessary for latent TB.

Answer: c) Short-course regimens like 3 months of once-weekly isoniazid plus rifapentine.

15. A patient being treated for bacterial meningitis is not improving. A lumbar puncture is repeated. What finding would suggest treatment failure?

• a) Decreased white blood cell count in the CSF.
• b) Increased glucose concentration in the CSF.
• c) Persistent positive Gram stain or culture of the CSF after 48 hours of therapy.
• d) Decreased protein level in the CSF.

Answer: c) Persistent positive Gram stain or culture of the CSF after 48 hours of therapy.

16. Prophylaxis for Toxoplasma gondii encephalitis is recommended in HIV patients with a positive IgG serology when their CD4 count drops below:

• a) 500 cells/mm³
• b) 200 cells/mm³
• c) 100 cells/mm³
• d) 50 cells/mm³

Answer: c) 100 cells/mm³

17. Rifampin is a potent inducer of many CYP450 enzymes. This can lead to a significant interaction with which of the following drug classes?

• a) Beta-blockers
• b) Statins
• c) Oral contraceptives
• d) All of the above

Answer: d) All of the above

18. A key component of the initial management of infective endocarditis is:

• a) Starting empiric antibiotics immediately after a single blood draw.
• b) Obtaining multiple sets of blood cultures before initiating antibiotic therapy.
• c) Delaying antibiotics until an echocardiogram is performed.
• d) Administering anticoagulants to prevent emboli.

Answer: b) Obtaining multiple sets of blood cultures before initiating antibiotic therapy.

19. Which antiretroviral medication requires food for adequate absorption and is part of many single-tablet regimens?

• a) Efavirenz
• b) Tenofovir disoproxil fumarate (TDF)
• c) Dolutegravir
• d) Elvitegravir (when boosted with cobicistat)

Answer: d) Elvitegravir (when boosted with cobicistat)

20. A patient with active TB is found to have a strain resistant to both isoniazid and rifampin. This is defined as:

• a) Extensively drug-resistant TB (XDR-TB)
• b) Primary resistance
• c) Multidrug-resistant TB (MDR-TB)
• d) Treatment failure

Answer: c) Multidrug-resistant TB (MDR-TB)

21. A common adverse effect of ethambutol that requires routine monitoring is:

• a) Hepatotoxicity
• b) Peripheral neuropathy
• c) Optic neuritis (changes in visual acuity and color vision)
• d) Hyperuricemia

Answer: c) Optic neuritis (changes in visual acuity and color vision)

22. An HIV-positive pregnant woman is on a stable ART regimen. What is the primary goal of therapy during pregnancy?

• a) To discontinue ART to protect the fetus.
• b) To maintain a viral load below the limit of detection to prevent mother-to-child transmission.
• c) To switch to a less potent regimen.
• d) To treat the infant with ART after birth instead of the mother during pregnancy.

Answer: b) To maintain a viral load below the limit of detection to prevent mother-to-child transmission.

23. Which of the following is a common pathogen causing meningitis in neonates (<1 month old)?

• a) Neisseria meningitidis
• b) Streptococcus pneumoniae
• c) Haemophilus influenzae type b
• d) Group B Streptococcus (S. agalactiae)

Answer: d) Group B Streptococcus (S. agalactiae)

24. The combination of pyrimethamine and sulfadiazine is the preferred treatment for:

• a) Mycobacterium avium complex (MAC)
• b) Pneumocystis jirovecii pneumonia (PJP)
• c) Toxoplasma gondii encephalitis
• d) Infective endocarditis

Answer: c) Toxoplasma gondii encephalitis

25. A patient on a protease inhibitor-based ART regimen should be monitored for which metabolic complication?

• a) Hypoglycemia
• b) Hyperlipidemia and hyperglycemia
• c) Weight loss
• d) Hypotension

Answer: b) Hyperlipidemia and hyperglycemia

26. Empiric therapy for infective endocarditis in a patient with a prosthetic valve placed less than a year ago should include coverage for:

• a) Only gram-positive organisms.
• b) Coagulase-negative staphylococci, including MRSA.
• c) Fungal pathogens.
• d) Atypical bacteria.

Answer: b) Coagulase-negative staphylococci, including MRSA.

27. The continuation phase of therapy for drug-susceptible active TB typically consists of:

• a) Four months of isoniazid and rifampin.
• b) Six months of pyrazinamide and ethambutol.
• c) Two months of isoniazid and rifampin.
• d) One month of RIPE therapy.

Answer: a) Four months of isoniazid and rifampin.

28. An HIV patient with a CD4 count of 40 cells/mm³ should be started on prophylaxis for which opportunistic infection, in addition to PJP and Toxoplasmosis?

• a) Herpes simplex virus (HSV)
• b) Mycobacterium avium complex (MAC)
• c) Candidiasis
• d) Cytomegalovirus (CMV)

Answer: b) Mycobacterium avium complex (MAC)

29. What is the recommended prophylactic agent for MAC disease?

• a) Rifampin
• b) Azithromycin or clarithromycin
• c) Trimethoprim-sulfamethoxazole
• d) Isoniazid

Answer: b) Azithromycin or clarithromycin

30. The drug class NRTI (Nucleoside Reverse Transcriptase Inhibitors) works by:

• a) Preventing the virus from entering the CD4 cell.
• b) Acting as a chain terminator during the conversion of viral RNA to DNA.
• c) Preventing the maturation of new virus particles.
• d) Blocking the integration of the viral genome.

Answer: b) Acting as a chain terminator during the conversion of viral RNA to DNA.

31. In meningitis, CSF analysis typically shows which pattern for a bacterial infection?

• a) High glucose, low protein, low WBCs (lymphocytic predominance).
• b) Normal glucose, normal protein, normal WBCs.
• c) Low glucose, high protein, high WBCs (neutrophilic predominance).
• d) High glucose, high protein, low WBCs (neutrophilic predominance).

Answer: c) Low glucose, high protein, high WBCs (neutrophilic predominance).

32. The “HACEK” group of organisms are fastidious gram-negative bacteria that are a rare cause of which complex infection?

• a) Tuberculosis
• b) Meningitis
• c) Infective Endocarditis
• d) HIV

Answer: c) Infective Endocarditis

33. What is Directly Observed Therapy (DOT) in the context of tuberculosis treatment?

• a) A type of diagnostic test.
• b) A strategy where a healthcare worker watches the patient swallow each dose of medication.
• c) A surgical procedure to remove infected lung tissue.
• d) The use of over-the-counter medications for TB.

Answer: b) A strategy where a healthcare worker watches the patient swallow each dose of medication.

34. Which antiretroviral agent is known for causing vivid dreams and CNS side effects, and is recommended to be taken on an empty stomach at bedtime?

• a) Dolutegravir
• b) Darunavir
• c) Efavirenz
• d) Raltegravir

Answer: c) Efavirenz

35. A patient with endocarditis caused by Enterococcus faecalis is often treated with a combination of a cell-wall active agent (like ampicillin or vancomycin) and which other antibiotic for synergy?

• a) An aminoglycoside (like gentamicin or streptomycin).
• b) A macrolide (like azithromycin).
• c) A tetracycline (like doxycycline).
• d) A fluoroquinolone (like levofloxacin).

Answer: a) An aminoglycoside (like gentamicin or streptomycin).

36. A patient taking pyrazinamide for TB should be monitored for an increase in which laboratory value?

• a) Serum creatinine
• b) Serum potassium
• c) Serum uric acid
• d) Serum glucose

Answer: c) Serum uric acid

37. Maraviroc, an HIV entry inhibitor, works by blocking which co-receptor?

• a) CD4
• b) GP120
• c) CCR5
• d) CXCR4

Answer: c) CCR5

38. Which of the following is an example of a single-tablet, complete ART regimen for HIV?

• a) Rifampin
• b) Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
• c) Valganciclovir
• d) Acyclovir

Answer: b) Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)

39. When should adjunctive corticosteroid therapy be initiated relative to the first antibiotic dose in appropriate patients with bacterial meningitis?

• a) 24 hours after the first antibiotic dose.
• b) Concurrently with or just before the first antibiotic dose.
• c) Only if the patient’s condition worsens after 48 hours.
• d) After the full course of antibiotics is complete.

Answer: b) Concurrently with or just before the first antibiotic dose.

40. A patient with a history of intravenous drug use is at highest risk for which type of infective endocarditis?

• a) Left-sided, mitral valve endocarditis.
• b) Right-sided, tricuspid valve endocarditis.
• c) Aortic valve endocarditis.
• d) Prosthetic valve endocarditis.

Answer: b) Right-sided, tricuspid valve endocarditis.

41. What is the goal of the initial, intensive phase of TB treatment?

• a) To cure the infection completely.
• b) To rapidly reduce the bacterial load and prevent the emergence of drug resistance.
• c) To manage the side effects of the medications.
• d) To treat the latent form of the infection.

Answer: b) To rapidly reduce the bacterial load and prevent the emergence of drug resistance.

42. Tenofovir disoproxil fumarate (TDF) is associated with what potential long-term toxicities?

• a) CNS side effects and rash.
• b) Lactic acidosis and hepatic steatosis.
• c) Nephrotoxicity and loss of bone mineral density.
• d) Hyperlipidemia and insulin resistance.

Answer: c) Nephrotoxicity and loss of bone mineral density.

43. A diagnosis of meningitis in a pediatric patient is often confirmed by:

• a) A CT scan of the head.
• b) An electroencephalogram (EEG).
• c) Analysis of cerebrospinal fluid (CSF) obtained via lumbar puncture.
• d) A routine blood test.

Answer: c) Analysis of cerebrospinal fluid (CSF) obtained via lumbar puncture.

44. In HIV management, what does an “undetectable” viral load signify?

• a) The patient is cured of HIV.
• b) The amount of HIV in the blood is below the level that the test can measure, and the risk of transmission is effectively zero.
• c) The patient no longer needs to take antiretroviral therapy.
• d) The virus has become resistant to all medications.

Answer: b) The amount of HIV in the blood is below the level that the test can measure, and the risk of transmission is effectively zero.

45. Which of the following is a classic skin manifestation of infective endocarditis?

• a) Psoriatic plaques
• b) Osler’s nodes (painful nodules on the fingers and toes)
• c) Urticaria (hives)
• d) Bullous pemphigoid

Answer: b) Osler’s nodes (painful nodules on the fingers and toes)

46. Which TB medication can cause drug-induced lupus erythematosus?

• a) Rifampin
• b) Ethambutol
• c) Pyrazinamide
• d) Isoniazid

Answer: d) Isoniazid

47. A patient with HIV develops oral thrush (candidiasis). What is the most appropriate initial treatment?

• a) Intravenous amphotericin B.
• b) Oral fluconazole.
• c) Topical nystatin suspension.
• d) Oral terbinafine.

Answer: c) Topical nystatin suspension.

48. Why is combination therapy with multiple antiretroviral agents from different classes used to treat HIV?

• a) To increase the pill burden for the patient.
• b) To maximize the potential for drug interactions.
• c) To suppress viral replication effectively and reduce the likelihood of developing drug resistance.
• d) Because single-agent therapy is more expensive.

Answer: c) To suppress viral replication effectively and reduce the likelihood of developing drug resistance.

49. For a patient with meningitis caused by Neisseria meningitidis, what additional public health measure is crucial?

• a) Placing the patient in a negative pressure room.
• b) Providing chemoprophylaxis to close contacts of the patient.
• c) Screening all hospital staff for the infection.
• d) Closing the hospital to new admissions.

Answer: b) Providing chemoprophylaxis to close contacts of the patient.

50. What is a primary role for the pharmacist in the management of complex infectious diseases?

• a) Performing surgical debridement of infected tissue.
• b) Reviewing culture and sensitivity data to recommend appropriate antimicrobial therapy.
• c) Obtaining informed consent for invasive procedures.
• d) Administering intravenous medications at the bedside.

Answer: b) Reviewing culture and sensitivity data to recommend appropriate antimicrobial therapy.